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Indication:

Performed for all the indications for hysterectomy like Fibroid, Adenomyosis, PID, Medical treatment failure with DUB (Excessive period and painful period), pain in lower abdomen, prolapse etc. Removal of ovaries is discussed with patient to understand menopausal protocols in future after removal of uterus.

Objective:

Today most of the Gynecologists advise Total Laparoscopic Hysterectomy for removal of Uterus with vaginal suturing done Laparoscopically, as the best and safe method for most of the indications. PID, Tuberculosis, Endometriosis & past surgeries are the commonest causes of adhesions around pelvic genital organs and anterior abdominal wall. So all the hysterectomy today is advised to be removed Laparoscopically for obvious benefits. Post Laparotomy adhesions are found in 20-70% of cases following various Gynecological surgeries leading to subsequent abdominal wall adhesions & postoperative pain requiring Laparoscopic Adhesiolysis. Fact may inspire all patients to ask primary surgeon for not offering initial Gynaec surgery by Laparoscopic approach. Adhesiolysis is the most rewarding surgery in pain relief. So patients with previous one/two/three/four LSCSs, big uterine mass is better and safely treated laparoscopically.

Benefits of Laparoscopy Surgery:

Shorter Hospital stay,

Earlier return to your routine work,

Cosmetically vary small scar,

Less pain after operation,

Best fertility enhancement & Fertility results following Laparoscopy,

Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).

The possibility of post-operative adhesion formation will be less, and the possibility of pain because of post-operative adhesions will also be less. Chances of Vault prolapse are less,

Redo surgery are less,

Sexual quality function is better after removal of uterus and best chances of safely removal of adnexa/ovaries during hysterectomy without damaging intestine, Ureter and bladder in difficult cases.

No. Of Cuts on Abdomen:
Four cuts: all of 5 mm size.
Average Stay in Hospital:
12-24 hours. (DAY CARE SURGERY)
Average Duration of Surgery:
60-90 minutes
Average Blood loss during Surgery:
20-40 cc
Average time after operation to resume normal activities/work:
Within 24 hours.
Anesthesia:
General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery)

Operative Procedure:

Inside the Umbilicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.
Performing laparoscopy usually only requires four tiny incisions less than one half inch, (about 5-10 millimeters) in length. With previous midline scar on abdomen, we generally introduce verres needle through palmer’s point and then first 5 mm port is introduced through Palmer’s point. . This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable. With help of palmer’s point port, second 5 mm port is kept supra umbilically on vision above the midline intra abdominal midline adhesions. Third & fourth ports are kept on Tr. & Lt side near anterior superior iliac spine on vision. Adhesiolysis is done with Bipolar & scissor and adhesions are stretched from one side simultaneously.

Most of the time many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 55 to 75 minutes only. For more complicated case it may take 1-2 hour. Most begin feeling much better within one day.